PracticalDermatology

A recent article published by The New York Times (“Patients' Costs Skyrocket: Specialists' Incomes Soar,” Jan 18th, 2014, Elisabeth Rosenthal, MD), methodically dismantles decades of careful attention by dermatologists to cost containment, skin cancer education, and advances in skin cancer treatment. Sadly, it dredges up every way possible to inaccurately portray dermatologists, and the results will likely reverse hard-fought gains in the battle to properly care for skin cancer patients. Dermatologists are painted with a class-warfare brush—pitting doctor against doctor—aimed at eliminating the top echelons of income producers, whomever they may be.

The response has been quick—yet muted—by our leaders and proponents of dermatology and I can't blame them. “Never pick an argument with a man who buys ink by the barrel,” (attributed to Mark Twain, but actually stated by William I. Greener, Jr.) is a very wise quote that relates directly to this situation.

The reality here is that the article ridicules Mohs surgery in particular and dermatology in general. Moreover, it presents a narrative of rich doctors earning too much money who are ignorant of patient preferences. The author prominently cites one case in which a doctor first uses inappropriate methods to remove skin cancers without recognizing patients' desires and then sends the same patients to other practitioners for the resultant repair, again disregarding the patients' preferences. In the case considered, there would seem to be a very reasonable set of actions by the dermatologist in question. The skin cancer was near the eye and had been misdiagnosed by a family doctor. Why was the dermatologist castigated for treating it correctly, while the family physician who didn't diagnose it earlier wasn't even discussed? The end result of this patient's experience experience with the dermatologist was that she was appropriately referred to a plastic surgeon for the closure and that surgeon (plus the anesthesiologist and the facility where the closure was performed) charged her approximately $24,000 for said repair. Somehow, the fact that the dermatologist charged $1,800 for the Mohs surgery (if this was correct) was forgotten, and the repair, including its significant charges and hospital care, was implicitly attributed solely to the dermatologist.

Many graphs and explanations accompany the article, but the significance of these is lost amid the heated rhetoric. Sadly, this sort of misguided article—written by a Harvard-trained internist, no less—could have appeared anywhere and will likely occur more frequently in the future, due to our cultural obsession with physician incomes.

If there are any positive take-home messages for dermatologists from this unfortunate and misleading story, they elude me. Fratricide, all in the name of a good story, is a reflection of the same behavior by many elected officials who delight in receiving advice and care from physicians and then subsequently pass legislation that hinders the ability of these same physicians to practice, while arguably harming patients at the same time. This article should therefore serve to remind all of us that we are on our own when it comes to the news media and how our success is presented. No one would dare explain how this hapless reporter completely misses the boat, or point out that the dermatologist actually lost money by sending this patient to a plastic surgeon (yet was accused of avarice at the same time). Nor will the average individual understand why this sort of article will lead to more expenditures for skin cancer over time in response to its scare tactics and misinformation.

Is this the future of medical reporting? Let's hope not!

—Joel Schlessinger, MD, FAAD

Chief Cosmetic Surgery Editor